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    Chronic Myelogenous Leukemia Treatment (PDQ®): Treatment - Patient Information [NCI] - General Information About Chronic Myelogenous Leukemia

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    Signs and symptoms of chronic myelogenous leukemia include fever, night sweats, and tiredness.

    These and other signs and symptoms may be caused by CML or by other conditions. Check with your doctor if you have any of the following:

    • Feeling very tired.
    • Weight loss for no known reason.
    • Night sweats.
    • Fever.
    • Pain or a feeling of fullness below the ribs on the left side.

    Sometimes CML does not cause any symptoms at all.

    Most people with CML have a gene mutation (change) called the Philadelphia chromosome.

    Every cell in the body contains DNA (genetic material) that determines how the cell looks and acts. DNA is contained inside chromosomes. In CML, part of the DNA from one chromosome moves to another chromosome. This change is called the "Philadelphia chromosome." It results in the bone marrow making an enzyme, called tyrosine kinase, that causes too many stem cells to become white blood cells (granulocytes or blasts).

    The Philadelphia chromosome is not passed from parent to child.
    cdr0000533336.jpg
    Philadelphia chromosome. A piece of chromosome 9 and a piece of chromosome 22 break off and trade places. The bcr-abl gene is formed on chromosome 22 where the piece of chromosome 9 attaches. The changed chromosome 22 is called the Philadelphia chromosome.

    Tests that examine the blood and bone marrow are used to detect (find) and diagnose chronic myelogenous leukemia.

    The following tests and procedures may be used:

    • Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease such as an enlarged spleen. A history of the patient's health habits and past illnesses and treatments will also be taken.
    • Complete blood count (CBC) with differential: A procedure in which a sample of blood is drawn and checked for the following:
      • The number of red blood cells and platelets.
      • The number and type of white blood cells.
      • The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
      • The portion of the blood sample made up of red blood cells.

      cdr0000526546.jpg
      Complete blood count (CBC). Blood is collected by inserting a needle into a vein and allowing the blood to flow into a tube. The blood sample is sent to the laboratory and the red blood cells, white blood cells, and platelets are counted. The CBC is used to test for, diagnose, and monitor many different conditions.
    • Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it.
    • Bone marrow aspiration and biopsy: The removal of bone marrow, blood, and a small piece of bone by inserting a needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for abnormal cells.
      cdr0000554337.jpg
      Bone marrow aspiration and biopsy. After a small area of skin is numbed, a Jamshidi needle (a long, hollow needle) is inserted into the patient's hip bone. Samples of blood, bone, and bone marrow are removed for examination under a microscope.

      One of the following tests may be done on the samples of blood or bone marrow tissue that are removed:

      • Cytogenetic analysis: A test in which cells in a sample of blood or bone marrow are viewed under a microscope to look for certain changes in the chromosomes, such as the Philadelphia chromosome.
      • FISH (fluorescence in situ hybridization): A laboratory technique used to look at genes or chromosomes in cells and tissues. Pieces of DNA that contain a fluorescent dye are made in the laboratory and added to cells or tissues on a glass slide. When these pieces of DNA bind to specific genes or areas of chromosomes on the slide, they light up when viewed under a microscope with a special light.
      • Reverse transcriptionpolymerase chain reaction test (RT–PCR): A laboratory test in which cells in a sample of tissue are studied using chemicals to look for certain changes in the structure or function of genes.
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